Release of the A1 Pulley for Trigger Finger Complicated by Flexor Tenosynovitis

Ricci, Joseph A.; Parekh, Nirav N.; Desai, Naman S.

doi:10.1007/s12593-015-0171-9

Cited by 3 publications

(3 citation statements)

References 10 publications

(22 reference statements)

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“…11e14 In general, the risk for adverse events after trigger finger release surgery is low, but deep infection consistent with suppurative flexor tenosynovitis has been reported. 15,16 The purpose of our study was to evaluate the association of corticosteroid injections and infection rate after subsequent trigger finger release surgery. Our hypothesis was that corticosteroid injections would be associated with an increased risk for infection and that the risk would be time dependent with injections closer to surgery carrying greater risk.…”

mentioning

confidence: 99%

Risk of Infection in Trigger Finger Release Surgery Following Corticosteroid Injection

Matzon

Lebowitz

Graham

et al. 2020

The Journal of Hand Surgery

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Purpose To determine the risk for infection in trigger finger release surgery after preoperative corticosteroid injection.Methods We retrospectively evaluated all patients undergoing trigger finger release by 16 surgeons over a 2-year period. Data collected included demographic information, medical comorbidities, trigger finger(s) operated on, presence of a prior corticosteroid injection, date of most recent corticosteroid injection, postoperative signs of infection, and need for surgery owing to deep infection. Superficial infection was defined per Centers for Disease Control criteria. Deep infection was defined as the need for surgery related to a surgical site infection. ResultsIn this cohort of 2,480 fingers in 1,857 patients undergoing trigger release surgery, 53 (2.1%) developed an infection (41 superficial [1.7%] and 12 deep [0.5%]). Before surgery, 1,137 fingers had no corticosteroid injection. These patients developed 1 deep (0.1%) and 17 superficial (1.5%) infections. In contrast, 1,343 fingers had been given a corticosteroid injection before surgery. These patients developed 11 deep (0.8%) and 24 superficial (1.8%) infections. Median time from corticosteroid injection to trigger release surgery was shorter for fingers that developed a deep infection (63 days) compared with those that developed no infection (183 days). The risk for developing a deep infection in patients who were operated on within 90 days of an injection (8 infections in 395 fingers) was increased compared with patients who were operated on greater than 90 days after an injection (3 infections in 948 fingers).Conclusions Preoperative corticosteroid injections are associated with a small but statistically significantly increased rate of deep infection after trigger finger release surgery. The risk for postoperative deep infection seems to be time dependent and greater when injections are performed within 90 days of surgery, especially in the 31-to 90-day postinjection period. (J

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confidence: 99%

Risk of Infection in Trigger Finger Release Surgery Following Corticosteroid Injection

Matzon

Lebowitz

Graham

et al. 2020

The Journal of Hand Surgery

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“…Werner et al 4 reviewed more than 200 000 patients through a Medicare database and reported less than 1% infection rate of any type. In 2015, Ricci et al 5 published a single case report of a patient who developed true infectious flexor tenosynovitis following A1 pulley release with a concomitant steroid injection.…”

Section: Introductionmentioning

confidence: 99%

Infectious Flexor Tenosynovitis Following Trigger Finger Release: Incidence and Risk Factors

Stewart

Ward

2020

Hand (New York, N,Y.)

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Background: Trigger finger release (TFR) is one of the most commonly performed hand procedures and typically results in restoration of normal finger function. However, uncommon postoperative complications such as deep infection can have devastating consequences. The goal of this study was to evaluate the incidence, risk factors, and characteristics of infectious flexor tenosynovitis occurring after TFR. Methods: We searched billing records for the Current Procedural Terminology code for TFR to identify all adult patients who underwent TFR at our institution over a 10-year period. We defined infectious tenosynovitis as any case where the patient underwent tendon sheath drainage or postoperative wound debridement within 6 months of the index TFR procedure. Medical records were reviewed to obtain patient demographic information, body mass index (BMI), tobacco use, history of diabetes mellitus, surgical setting (clinic vs outpatient surgery center), and surgical digit for all patients. In those patients treated for infection, we recorded hospital length of stay, number of operative procedures, and any culture results. Results: We identified a total of 18 infections out of 2307 procedures (1827 patients), for an incidence of 0.99%. Current smokers had a significantly higher incidence of infection than nonsmokers (1.77% vs 0.29%). On univariate analysis, smoking was closely associated with infection ( P ≤ .05). All infections occurred in overweight or obese patients by BMI criteria, but there was no difference in average BMI between patients with and without infection. History of diabetes, in-office surgery, patient age, and patient sex were not associated with a higher incidence of infection. Patients with infections spent an average of 4.1 days in the hospital, and 40% required multiple surgical procedures. The most common infectious organism cultured was Staphylococcus aureus, which was present in 67% of infections. Patients with isolated methicillin-sensitive S aureus on culture showed signs of infection within 3 weeks of the index procedure, whereas polymicrobial, coagulase-negative staphylococci or beta hemolytic streptococci were identified in patients presenting with infectious symptoms later. Conclusion: Infections after TFR are uncommon but are more likely to occur in patients who are current smokers and overweight or obese by BMI criteria. Methicillin-sensitive S aureus is the most likely causative organism, especially in patients presenting during the early postoperative course.

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“…golf, tennis). Adverse events between 5 and 36 % in the setting of trigger finger release have been reported [ 11 – 15 ], including persistent triggering, recurrence and wound healing problems such as infections, wound dehiscence, and painful scar tissue irritation. Anecdotic events involve tendon rupture, bowstringing, and nerve damage [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of three different incision techniques in A1 pulley release on scar tissue formation and postoperative rehabilitation

Kloeters

Ulrich

Bloemsma

et al. 2016

Arch Orthop Trauma Surg

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IntroductionThe optimal surgical approach for trigger finger release remains controversial in hindsight of postoperative rehabilitation as well as scar tissue formation. In this study, we comparatively evaluated the outcome of three different types of skin incision by employing the “Disability of the Arm Shoulder and Hand Score” (DASH) and by quantitative ultrasound measurements of scar tissue volume.Materials and methodsThirty patients (32 triggerfingers) were enrolled in this study and randomly assigned to one of three groups: incision placed (1) transversal in distal palmar crease, (2) transversal and 2 mm distal from distal palmar crease, (3) longitudinally over MCP joint without crossing the distal palmar crease. Patients characteristics were noted and DASH scores were retrieved at four time points, (1) preoperatively (baseline), (2) 1 month, (3) 3 months, (4) 12 months postoperatively. Scar volume formation was assessed by ultrasound at 3 months postoperatively in 28 patients.ResultsAll groups showed a significant reduction in DASH values at 3 and 12 months postoperatively when compared to their own baseline levels. Group 3 showed the fastest and most pronounced reduction in DASH values at 1 month. Scar tissue formation was almost 57 % increased in group 1 vs group 2 and 3, however, not significant.ConclusionThere is no clear benefit of one incision technique over another. However, based on scar volume parameters, the significant faster recovery in the first month and the surgical ease of exposure and wound closure inclines us to favor the longitudinal incision (group 3) in future patients.

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Release of the A1 Pulley for Trigger Finger Complicated by Flexor Tenosynovitis

Cited by 3 publications

References 10 publications

Risk of Infection in Trigger Finger Release Surgery Following Corticosteroid Injection

Risk of Infection in Trigger Finger Release Surgery Following Corticosteroid Injection

Infectious Flexor Tenosynovitis Following Trigger Finger Release: Incidence and Risk Factors

Comparison of three different incision techniques in A1 pulley release on scar tissue formation and postoperative rehabilitation

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